VBP QIP AIT Attestation

Submission Guidelines

• Attestation is also available in Portable Document Format (PDF)

Each Facility participating in the Value Based Purchasing Quality Improvement Program (VBP QIP) is expected to provide Annual Improvement Target (AIT) results annually. The report on AIT performance must be accompanied by an attestation signed by a senior leader within the facility confirming the accuracy of both the baseline period and measurement period data provided by the Facility.

VBP QIP Facilities must submit this attestation to their paired MCO together with their VBP QIP AIT Performance report. Refer to the VBP QIP Facility Plan Guidance Document for any questions on how to complete the Facility to MCO VBP QIP AIT Performance Report.

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Attestation

I, _____(Name)________________, employed by ______(Facility Name) ___________, as ________(Title)___________, hereby attest the baseline period year __(Year)___ and measurement period ___(Year)____ data provided in the Facility to MCO VBP QIP AIT Performance Report, has been reviewed and is deemed accurate.

Date                                    _______________________________

Authorizing Signature:     _______________________________